T Nation

New to TRT, Unique Case to Say the Least

Hi there, first time poster, long time follower of the site.
First off, I am a former finasteride user that stopped in 2011. I had horrible side effects. Depression, suicidality, no libido, impotence, loss of job, etc. One the course of a year or so I tried clomid and AI and in regained my potency and sperm. My T level was around 5nmol (8-28 normal) at that time. I was only 27 at the time. My T level went up to about a 15nmol/L and I felt stronger, Gained muscle and weight but never felt well.

I eventually had three kids, and kinda stopped thinking about Post finasteride syndrome. I actually would say I made a 80% recovery except my libido never came back fully. However, I always suspected my T levels were out of whack

Anyway, fast forward to 2020, I got some recent ED, and the mental doubt and suspicion and radar went off, so I blamed most on PFS, and got recent blood work
Total T 9nmol (9-28)
Estradiol-22 (11-44)
SHBG 23 (16-56nmol/L)
Bio available .6 (2.5-18nmol/L)
LH 1
FSH 1.8
T3 4.5 (2.6-5.8)
T4 14 (9-19)
prolactin–mid normal

One month later, T dropped to 4.4nmol (9-28 normal)
Clearly I’ve been secondary hypogonadic for quite some time. But, I felt I was doing relatively ok…the mental part is definitely a part of all of this

Started Androgel 5g, for last week and now Bioavailable is mid normal, total T back to about 9-10nmol/L but still obviously quite low.

My question is this…since Ive been doing relatively ok for the last several years–libido maybe 4/10 what it used to be years and years ago, erections fine, lack of morning erections though…will a guided TRT program for life help me even further to feel even better then I was before?

I know the Androgel is probably not the best route and am seeing someone who uses injections this Thursday…
I kind of hate that I need to go on TRT bc it tells me that I didn’t fully recover from PFS, however, if I felt ok for all these years with such low numbers, does it stand to reason I will feel even better once I get into a normal age matched range of hormones?

I know @samguy19 has experience here… @KSman seems to be well versed also…any help would be awesome

Also, one week of Androgel has caused my LH and FSH to be .1. and .2 respectively…I understand this is what normally happens,…

Probably. Your dose is most likely a little low, but I don’t know if you want to double it. It’s easier to adjust dose incrementally with the injections, You’ll probably want to start at 100 mg a week and see how that goes. Don’t start multiple thinga at once. Start with just test, and don’t worry about stuff like E2 unless you develop problems. Simple is better.

It’s amazing what the mind can do…I just assumed that clomid 9 years ago reset me and everything was working ok…the truth is I’ve probably been running on hormonal fumes
For years…this explains why I haven’t gained strength for years despite working out steadily…the depression has set back in now bc your mind tells you this is all finasteride related…and I suppose it is…but like I said I was feeling pretty good and life was good…I can only hope that restoring normal levels will get me feeling even better…libido…erections…depression

Yes.

Forget about the numbers, though they do explain your current situation and can be used as a guide. Many have low testosterone for years and seem fine, then the symptoms hit. That’s where you’re at now. Double your total testosterone, double your free testosterone, you’ll feel better.

Many guys do not realize just how bad they felt until the start TST. Then it is night and day.

What about all this finasteride shit that I dealt with…I certainly had side effects…my balls have been tight for years…penis changed a bit but functionally I was ok…Regardless I was relatively happy with my recovery…I don’t want to get in my own way too much

Not much you can do about the Finasteride issues (if you figure out the fix you could be rich as fuck) but many guys here have used TRT with success even with PFS (@ncsugrad2002 is one of them).

I personally had long term issues (depression, libido, erection strength) some of which stemmed from antidepressant use 15-20 years earlier, drug use, diet… The list goes on. TRT has been life changing for me. The way I feel now is better than I could have ever dreamed it to be. It definitely didn’t start out that way and took a while to finally get there. Along the way the there were some pretty hopeless times where I felt worse than before TRT. Anyways, stay diligent and you can get there. In my opinion, the sooner you switch to injections the better. You’ll be able to find tune your experience and stay consistent. Changes don’t happen over night and it can take a lot of patience but in the end it will be worth it.

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Yeah I have PFS as well, but a proper trt protocol bright me back to 100% (at least what I think 100% used to be). I thought I was checking naturally as well until I saw my free t was 7.5 and I was just kidding myself. Everyday was a nightmare and I wished I was dead. Trt saved my life.

Ncsu and I have high shbg, which you don’t so you may respond differently than we did but I’m sure you’ll be fine.

Ditch the gels, don’t worry too much about estrogen, get to the high end of the free t range, give it 10 weeks, forget about finasteride and be free.

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Ok thanks…what symptoms did you have from the PFS
I’d say the worse thing now is the depression it causes when you don’t feel libido or are having erection issues which come and go

I’m married also which is kind of hard right now

So switch to weekly 100mg injections is your recommendations?

And why is this better than androgel—which is a pain in the ass to use

The short answer is andro gel just flat out isn’t strong enough. Sometimes that’s because people don’t absorb it well, oftentimes it’s because there isn’t enough T in the normal dose of it to begin with, sometimes it’s a combination of the two.

IM injections are really the tried and true method that just works.

Yes, more than likely it would improve things for you. I actually didn’t feel that terrible when mine was that low but I had a bunch of sexual issues that were maddening (like, could barely get done once a week but did not really have erection issues so yeah, it’s was pretty frustrating to be ready to go but rarely got to the finish line–makes girls feel bad about themselves too but that’s a whole other topic). Genital sensitivity issues, etc. I’d basically be numb… hard, but numb. The weird part is I kept losing weight, had abs, etc. I’m assuming it’s from the super low Estrogen that comes with low T

I wouldn’t fixate on the “normal range” too much. A lot of regular docs will get you to the bottom end of the normal range and say “welp, you’re normal!” even though you might need to be at the top of the range or sometimes even higher than that to really feel like you used to. Shoot for what works, not what necessarily looks best on paper

I’ve been telling people to start at 150mg a week, 3x a week injections. I use insulin syringes to the delt and it’s the least painful way I’ve found to do it. Usually I don’t feel it at all. Occasionally I’ll have one that burns like hell, I guess when I hit a nerve or something… that happened last night but it’s rare.

That’s about it. I have a diary thread around here somewhere that has my whole history in it if you really want to read about my sex life for hours, haha. Short version is I had crazy high libido on finasteride for a while, it finally crashed, I stopped taking it, had some rebound improvements for a few weeks then went downhill and stayed there. Did some hormone testing and found I had crazy high SHBG (150 something), very low free T and low E2. I’m doing much better. I still don’t think I’m at the best I can be–I need to add some gym time and a somewhat decent diet to the mix to get the rest of the way there, but I’m way better than where I started.

I thought I was better

Then BAM
some new ED…horrible bloodwork and I’m back in this mess again

The mind plays a huge role in the whole PFS thing IMO also and worsens the symptoms of ED and libido…I think this doc may start me on 100mg of test injections…is it something you feel immediately? Like all of a sudden libido and erections? I’m a bit new to this but it probably takes some times

It’s weird bc in finasteride I had a crazy sex drive for a few years but slowly it decreases and I hardly noticed…I have no ideas what my t levels were pre Fin however I was always smaller and not someone who put on muscle easily at all, not very hairy but crazy sex drive years ago… so does that mean I had a low t level to begin with ?

1000%. Just getting off of the PFS forums probably made me 30% better, haha. They’re so depressing.

Same. Actually, the highest I’ve ever had was while I was on it. Mine went down for a while then came back like crazy. Then I went back and forth with taking and forgetting to take fin a few times and bam, full blown numb d.

It’s not usually an instant thing. There are cases where people claim that it is. My belief is a few of those are real (usually people with reallllly bad symptoms and super low T for long periods of time) but usually you can expect 8-12 weeks before you really get to feeling better. Every time I change my dose or anything like that it takes 8 weeks again before I feel better, so don’t expect instant results.

There’s no way to really know without lab work from back then… which I’m assuming you don’t have. I didn’t either. I really wish everyone in their “prime” would get bloodwork done so they know what their normal is, but even though I told me doc to run whatever bloodwork he wanted a few months before all this started, he didn’t run a single hormone or thyroid test.

First doc I seen just recommended 200mg every other week

Not sure if this is a good idea or not

Also I have never injected anything before haha

Is there away to just take some of the vial and keep the rest for later and do more frequent injections

Sorry if that’s a dumb question

Nope. If you have the vial and the needles, then you can do it how you want. 100mg once a week would be the minimumdose and dosage frequency for most. Some guys like twice a week, some guys like every day. Pick one and give it at least 6 weeks before you change anything.

So don’t do every two weeks 200mg?

No. Most guys hate an every two week frequency. It can be a rollercoaster.

I’ve increased the androgel to 1.5 packets a day until we start the injections

So much unknown it’s hard to be patient wow
This sucks !

It’s something I feel immediately as within minutes, how you respond to TRT is based on your current health problems and genetics.

Hormone profiles after intramuscular injection of testosterone enanthate in patients with hypogonadism

In fact, the present study confirmed serum levels of T which were lower than pre-ART value levels on day 14 after administration. Therefore the further decrease in serum T levels on day 14 after administration is considered to relapse of hypogonadal symptoms and to reduce the patients quality of life.

No.

If you have been suppressed for years is there a point to try clomid again? I Mean I doubt it would permanently restart things after all these years. The thing is I felt not that bad the last several years! Probably at very low T…
Second part…what do you guys do about your testicles shrinking—mentally—does this bother anyone? I feel like it would bother me looking at small balls however if you feel better it’s worth it?

Lastly—-at this point would you assume I’m on this TRT for life?